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  • br Repeated resections of recurrences may lead

    2020-08-07


    Repeated resections of recurrences may lead to good long-term survival; however, recurrence remains common. Many reports have demonstrated that 60e70% of patients develop recurrence within the first 2 years after an initial
    Please cite this article as: Yang KM et al., Benefits of repeated resections for liver and lung metastases from colorectal cancer, Asian Journal of Surgery, https://doi.org/10.1016/j.asjsur.2019.03.002
    + MODEL
    Figure 2 (A) Overall survival (OS) rates in the subgroup with second metastasectomy and the subgroup with nonsurgical treat-ment on second recurrence. (B) OS rate after the first metastasectomy. (C) Recurrence-free survival (RFS) rate after the first metastasectomy, second metastasectomy, and third metastasectomy.
    liver or lung resection.6,7,21 The most common recurrence sites after liver or lung resection were the liver and lungs. Yokata et al reported that following initial pulmonary re-sections (n Z 76), recurrences developed in the Cyclosporin H (n Z 37), liver (n Z 12), and other organs (n Z 11).22 Among these patient, 37 underwent metastasectomies, with 22 undergoing pulmonary resections, 11 hepatic re-sections, and two resections at other sites. After meta-stasectomy, the 3-year OS rate was 84.1% for the surgery group and 38.9% for the chemotherapy group (p < 0.001). Bellier et al21 reported that out of the 46 patients who underwent hepatic or pulmonary resections for initial re-currences, 35 (76.1%) experienced lung and/or liver relapse. Among these patients, 14 out of the 22 (63.3%) patients with recurrent liver metastasis could undergo repeat metastasectomies, in addition to 11 of the 24 pa-tients (45.8%) with recurrent pulmonary metastases. In our study, the distribution of first metastasectomy sites was as follows: liver, 115 patients; lungs, 117 patients; and liver and lungs, 16 patients. After the first metastasectomy, 133 patients developed a second recurrence (53.6%), among whom 95 patients (95/133, 71.4%) had liver or lung me-tastases and 38 (28.6%) had metastases at other sites, which primarily included peritoneal seeding. Of the 95 patients who had liver or lung metastases, 46 (46/95,
    48.4%) patients underwent a first repeat metastasectomy, while only seven patients (7/38, 18.4%) with recurrences at other sites underwent repeat metastasectomies. In select
    patients, repeated resections can provide good OS rate with acceptable mortalities for both liver5,11,21 and pul- monary metastases.9,12 Therefore, despite the high recur-rence rate, surgery provides a promising strategy for the treatment of isolated recurrences.
    Although the majority of patients in synapse study who un-derwent repeated resections had prolonged survivals, a third or even fourth resection should be considered care-fully. Several previous studies have reported the outcomes of repeated hepatic and pulmonary resections, with good
    long-term survival rates that are consistent with our re-sults.21,23 However, the recurrence rates in our series were
    significantly higher after the third metastasectomy. Recurrence rates after the first metastasectomy, second metastasectomy, and third metastasectomy were 54% (133/ 248), 52% (27/52), and 71% (10/14), respectively. The HR for RFS for the first and second repeat surgery was 1.142 and 2.590, respectively, in comparison with that of the first metastasectomy. Third metastasectomy showed signifi-cantly lower RFS rate compared to second metastasectomy (p Z 0.028). Although repeat metastasectomies may pro-vide prolonged survival, recurrence rates after a third
    Please cite this article as: Yang KM et al., Benefits of repeated resections for liver and lung metastases from colorectal cancer, Asian Journal of Surgery, https://doi.org/10.1016/j.asjsur.2019.03.002
    + MODEL
    Repeat metastasectomy from colorectal cancer 7
    Table 3 Univariate and multivariate analyses of factors associated with overall survival after the initial resection for the firstrecurrence.
    Variables Univariate
    Multivariate
    P-value
    Initial recurrence pattern <0.001*
    Recurrence free
    Resectable recurrence
    Unresectable recurrence
    Recurrence free interval after initial resection 0.042*
    6 months
    Resected tumor number of initial recurrence 0.439
    Resected organ number of initial recurrence 0.869
    Tumor location (primary tumor) 0.927
    Colon
    Rectum
    I
    II
    III
    Presence of lymphovascular invasion (primary tumor), yes 0.328
    Presence of perineural invasion (primary tumor), yes 0.857
    metastasectomy were significantly higher. Of the 14 pa-tients who underwent third metastasectomy, five died or had recurrences within 6 months, and eight died or had recurrences within 12 months. Therefore, third meta-stasectomy should be carefully considered.